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    How patient movement can interfere with femto laser-assisted cataract surgery


    The incident reinforces the need to identify patients who might present difficulties for laser treatment that might not be as significant for traditional phaco. Patients with deep-set orbits or very small eyes could be present challenges to femto laser treatment.

    Patients who are unable to hold still can also be problematic. Deeper sedation is not a viable option, Dr. Yoo said. Not only must patients be alert, responsive, and able to focus on a bright light as directed during the procedure, they must also be able to move themselves in and out of a lying position for the instrument used in this procedure.

    It is also important to realize that laser safety mechanisms can fail. While the laser should not be able to fire once suction is broken, it is possible that the device can sense suction even after the eye has moved if tissues such as the conjunctiva somehow occlude the suction holes.

    Related: How to incorporate FLACS technology

    Modifying the preoperative conversation and informed consent can be a useful strategy to deal with potential misadventures, she continued. The reality is that things do not always go as expected during any cataract surgery, not just FLACS. It particularly important to help the patient understand that surgical plans may change depending on how the procedure evolves. 

    “It is important to your pre-op discussion with the patient to explain that while you intend to use a laser and to implant a multifocal lens, there may be unforeseen circumstances which preclude the use of either and may require the use a monofocal lens in the interest of safety,” she said. “Safety for the patient is our first concern.”

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